Nonpharmacologic Treatments for Treatment-Resistant Depression

A number of non-pharmacologic neuromodulatory treatments for treatment- resistant depression have been developed and tested clinically, such as:

Electroconvulsive Therapy (ECT) that involves delivering electrical pulses to the brain via electrode pads positioned on the scalp above mood centers in the brain. These pulses cause an epileptic seizure, which results in global cerebral stimulation;

repetitive Transcranial Magnetic Stimulation (rTMS) that is a noninvasive technique involving the generation of a magnetic field that penetrates the skull and induces low-level electric currents in underlying tissue, thereby altering local neuronal function without inducing seizure;

transcranial Direct Current Stimulation (tDCS) that is a noninvasive neurostimulation method that delivers low-intensity electrical currents via 2 scalp electrodes to the cerebral cortex; and

Deep Brain Stimulation (DBS) that requires the implantation of quadripolar electrodes, which deliver electrical current directly into the brain.

Coverage decision: Covered with conditions ECT and rTMS may be covered if conditions are met; tDCS and DBS will not be covered. (Effective date: October 1, 2014).